Multidimensional Family Therapy

Transcription

1 Published December 2017 Downloaded from Multidimensional Family Therapy Review: September 2017 Multidimensional Family Therapy (MDFT) is primarily for adolescents who have substance misuse, behavioural, delinquency, mental health, educational/school, family mental health problems or disorders. MDFT is an integrated and flexible multi-component programme. Families work with a qualified MDFT therapist to develop problem-solving skills for dealing with issues that are occurring at the level of the adolescent, parent, family and community. It includes sessions focused on the youth, as well as sessions focused on the parents, and sessions directed towards the family overall. In addition, a community-focused component is available. Evidence rating: 4 Cost rating: 4 MDFT aims to improve education outcomes, reduce substance misuse, delinquency and involvement in the criminal justice system. EIF Guidebook > Multidimensional Family Therapy 1

2 EIF Programme Assessment Multidimensional Family Therapy has evidence of a long-term positive impact on child outcomes through multiple rigorous evaluations. Evidence rating: 4 What does the evidence rating mean? Level 4 indicates evidence of effectiveness. This means the programme can be described as evidence-based: it has evidence from at least two rigorously conducted evaluations (RCT/QED) demonstrating positive impacts across populations and environments lasting a year or longer. Please note that this evidence rating is based on three robust studies where MDFT outperforms three alternate treatments (individual cognitive behavioural therapy, individual psychotherapy, and adolescent group therapy) when targeted at young people with substance abuse issues, in the context of the US system. Readers interpreting this evidence should carefully consider the generalisability of these results to the delivery context in the UK (and what treatment-as-usual services are typically offered in the UK to this group). Cost rating A rating of 4 indicates that a programme has a medium-high cost to set up and deliver, compared with other interventions reviewed by EIF. This is equivalent to an estimated unit cost of 1,000 2,000. Cost rating: 4 EIF Guidebook > Multidimensional Family Therapy 2

3 Child outcomes According to the best available evidence for this programme's impact, it can achieve the following positive outcomes for children: Preventing crime, violence and antisocial behaviour Reduced externalising symptoms - based on study 2b, study 3 Reduced delinquency - based on study 3 Reduced felony arrests - based on study 3 Preventing substance abuse Reduced substance use problem severity - based on study 1 Reduced other drug use - based on study 1 Increased drug abstinence - based on study 1 Reduced cannabis dependence symptoms - based on study 2a EIF Guidebook > Multidimensional Family Therapy 3

4 Key programme characteristics Who is it for? The best available evidence for this programme relates to the following age-groups: Adolescents How is it delivered? The best available evidence for this programme relates to implementation through these delivery models: Individual Where is it delivered? The best available evidence for this programme relates to its implementation in these settings: Home Community centre In-patient health setting Out-patient health setting How is it targeted? The best available evidence for this programme relates to its implementation as: Targeted indicated EIF Guidebook > Multidimensional Family Therapy 4

5 Where has it been implemented? Belgium, Finland, France, Germany, Netherlands, Switzerland, United States UK provision This programme has not been implemented in the UK. UK evaluation This programme s best evidence does not include evaluation conducted in the UK. EIF Guidebook > Multidimensional Family Therapy 5

6 About the programme What happens during delivery? How is it delivered? MDFT is delivered by a qualified MDFT therapist. The youth-focused component of MDFT is typically delivered over the course of 8-20 individual therapy sessions (approx mins long). The parent-focused component of MDFT is typically delivered over the course of 4-10 sessions (approx hours long). The family-focused component of MDFT is typically delivered over the course of 4-10 sessions (approx hours long). In addition, there is a community-focused component which is delivered over 4-10 community sessions/meetings (approx hours long). Families work with the therapist for a period typically lasting four to six months. EIF Guidebook > Multidimensional Family Therapy 6

7 What happens during the intervention? MDFT intervenes in four connected areas: the adolescent, the parents, the family, and the community. Behavioural change is produced through a series of conversations between the therapist and youth in individual therapy sessions, between the therapist and parents in parent sessions, in family sessions where the therapist facilitates meaningful conversations among the family members who are presented, and in sessions between the family and social systems in their community. Homework is given to promote out of session changes, and phone calls to youth and parents are conducted to encourage change and problem solve through difficulties. Treatment is organised in three stages: Stage 1, Build a foundation for change: Therapists create an environment in which the youth and parents feel respected and understood. Therapists meet alone with each to establish a collaborative foundation for the changes to be sought. Stage 1 goals are to develop strong therapeutic relationships, achieve a shared developmental and contextual perspective on their problems, enhance motivation for individual reflection and self-examination, and begin the change process. Stage 2, Facilitate individual and family change: The focus of stage 2 is on behavioural and interactional change within youth and parents in their relationships. In the adolescent domain, MDFT focuses on improving youth self-awareness, self-worth and confidence; developing meaningful short-term and long-term goals; and improving emotional regulation, coping, problem-solving and communication skills. In the parent domain, the focus is on strengthening parental teamwork, improving parenting skills and practices, rebuilding parent-teen emotional bonds, and enhancing parent s individual functioning. In the family domain, MDFT works to improve family communication and problem-solving skills, strengthen emotional attachments and feelings of love and connection among family members, and improving everyday functioning of the family unit. In the community, the focus is on improving family members relationships with social systems including school, court, legal workplace and neighbourhood and building capacity to access needed resources. Stage 3, Solidify changes: The last few weeks of treatment strengthen the accomplishments achieved. The therapist amplifies changes and helps families create concrete plans for responding to future problems such as substance use relapse, family arguments, or any other kinds of setbacks or disappointments. Family members reflect on the changes made in treatment, acknowledge each other for the efforts they have made, see opportunities for a brighter future, and express hope for the next phase of their lives together. EIF Guidebook > Multidimensional Family Therapy 7

8 What are the implementation requirements? Who can deliver it? This programme is delivered by an MDFT Therapist with QCF-7/8 level qualifications. What are the training requirements? Therapists have 65 hours of programme training. Booster training of practitioners is recommended. How are the practitioners supervised? It is recommended that practitioners are supervised by on host-agency supervisor (qualified to QCF-7/8 level), with hours of programme training. What are the systems for maintaining fidelity? Programme fidelity is maintained through the following processes: Training manual Other printed material Other online material Video or DVD training Face-to-face training Fidelity monitoring. Is there a licensing requirement? There is no licence required to run this programme. EIF Guidebook > Multidimensional Family Therapy 8

9 How does it work? (Theory of Change) How does it work? Adolescent substance misuse, mental health and behavioural problems are multi-determined by processes occurring at the level of the child, parent, family and community. Specifically, adolescent problems are predicted by individual adolescent factors such as poor emotional regulation, parental factors such as individual functioning and inconsistent or ineffective parenting practices, disconnected or conflicted family relationships, and limited access to positive community supports and resources (eg peers, school, recreation), among others. The programme aims to improve adolescent self-awareness, life goal development, emotional and behavioural regulation, and communication skills; parental functioning (both individual and parenting team) and parenting practices; family emotional attachments and interactions, communication and problem solving skills; and family members capacity to access and implement needed resources and positive community supports (eg school, work, pro-social peers, social services). In the short term, youth emotional and behavioural regulation and communication skills are improved; youth have more purpose, meaning and hope for their lives; parenting functioning and parenting practices are improved; and family relationships and bonds are stronger by having closer emotional attachments and improved everyday functioning and problem-solving in the family unit as a whole. Involvement in pro-social peer relationships and activities and collaboration and negotiation with community systems also increase. In the longer term, the youth does better in school (academically and behaviourally); has reduced substance misuse, delinquency and involvement in the criminal justice system; reduced out-of-home placements; and has improved mental health. Intended outcomes Supporting children's mental health and wellbeing Enhancing school achievement & employment Preventing crime, violence and antisocial behaviour Preventing substance abuse Contact details Gayle A. Dakof, Ph.d (Director) gdakof@mdft.org EIF Guidebook > Multidimensional Family Therapy 9

10 About the evidence MDFT s most rigorous evidence comes from three RCTs which were conducted in the USA, and across Belgium, Germany, France, the Netherlands and Switzerland. This programme has evidence from three rigorously conducted RCTs, with at least one study demonstrating long-term impact, as well as demonstrating impact on assessment measures independent of study participants (not self-reports). Subsequently, the programme receives a level 4 rating overall. Study 1 Citation: Liddle et al. (2008) Design: RCT Country: United States Study rating: 3 Sample: 224 drug-using adolescents between the ages of 12 and 17.5 years old (mean = 15) Timing: Between baseline and 12-months follow-up Child outcomes: Reduced substance use problem severity Reduced other drug use Increased drug abstinence Other outcomes: None measured Liddle, H. A., Dakof, G. A., Turner, T. M., Henderson, C. E., Greenbaum, P. E. (2008). Treating adolescent drug abuse: a randomized trial comparing multidimensional family therapy and cognitive behavior Therapy. Addiction, 103, doi: /j x Available at EIF Guidebook > Multidimensional Family Therapy 10

11 Study Design and Sample The first study is a rigorously conducted RCT. This study involved random assignment of children to an MDFT group and an individual cognitive behavioural therapy group. This study was conducted in the USA with a sample of adolescents between the ages of 12 and 17.5 years old (mean = 15) who were using drugs. Measures Substance use problem severity was assessed using the Personal Experience Inventory PEI (adolescent self-report). 30-day frequency of cannabis use, alcohol use, other drugs, and 30-day abstinence was assessed using the Time-line Follow-back Method (adolescent self-report). Findings This study identified statistically significant positive impact on a number of child outcomes. This includes substance use problem severity, other drug use, and drug abstinence. Study 2a Citation: Rigter et al Design: RCT Country: Belgium, France, Germany, Netherlands and Switzerland Study rating: 3 Sample: 450 adolescents between ages of 13 and 18 years old, all with recently diagnosed cannabis use disorder Timing: Change from baseline to 9-months post-intervention Child outcomes: Reduced cannabis dependence symptoms Other outcomes: None measured Rigter, H., Henderson, C. E., Pelc, I., Tossmann, P., Phan, O., Hendriks, V., Rowe, C. L. (2013). Multidimensional family therapy lowers the rate of cannabis dependence in adolescents: A randomised controlled trial in Western European outpatient settings. Drug and Alcohol Dependence, 130, doi: /j.drugalcdep Available at EIF Guidebook > Multidimensional Family Therapy 11

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13 Study Design and Sample The second study is a rigorously conducted RCT. This study involved random assignment of children to an MDFT group and an individual psychotherapy group. This study was conducted across five western European countries (Belgium, Germany, France, Netherlands, Switzerland) with a sample of adolescents between ages of 13 and 18 years old, all with recently diagnosed cannabis use disorder. Measures Prevalence of cannabis use disorder was measured using the Adolescent Diagnostic Interview-Light (clinical interview). 90-day frequency of cannabis consumption was measured using the Time-line Follow-back Method (adolescent self-report). Findings This study identified statistically significant positive impact on a number of child outcomes. This includes cannabis dependence symptoms. Study 2b Citation: Schaub et al Design: RCT Country: Belgium, France, Germany, Netherlands and Switzerland Study rating: 3 Sample: 450 adolescents between ages of 13 and 18 years old, all with recently diagnosed cannabis use disorder Timing: Change from baseline to 9-months post-intervention Child outcomes: Reduced externalising symptoms Other outcomes: None measured Schaub, M. M., Henderson, C. E., Pelc, I., Tossmann, P., Phan, O., Hendricks V., Rowe, C. L., & Rigter, H. (2014). Multidimensional family therapy decreases the rate of externalising behavioural disorders symptoms in cannabis abusing adolescents: outcomes of the INCANT trial. BMC Psychiatry, 14, 26. doi: / X Available at EIF Guidebook > Multidimensional Family Therapy 13

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15 Shaub et al describes additional outcomes from study 2a described above. In this case: Internalising and externalising symptoms were measured using the Youth Self-Report (adolescent self-report). Internalising and externalising symptoms were also measured using the Child Behaviour Checklist (parent report). Family conflict and cohesion were assessed using the Family Conflict and Cohesion subscales of the Family Environment Scale (adolescent self-report). This study identified statistically significant positive impact on a number of child outcomes. This includes externalising symptoms (youth self-report). Study 3 Citation: Dakof et al. (2015). Design: RCT Country: United States Study rating: 3 Sample: 112 adolescents between the ages of 13 and 19 (mean = 16.1) diagnosed with substance abuse problems or dependency Timing: Post-test to 18-month follow-up Child outcomes: Reduced delinquency Reduced externalising symptoms Reduced felony arrests Other outcomes: None measured Dakof, G. A., Henderson, C. S., Rowe, C. L, Boustani, M., Greenbaum, P., Wang, W., Hawes, S., Linares, C., & Liddle, H. A. (2015). A randomized controlled trial of multidimensional family therapy in juvenile drug court. Journal of Family Psychology, 29, doi: /fam Available at EIF Guidebook > Multidimensional Family Therapy 15

16 Study Design and Sample The third study is a rigorously conducted RCT. This study involved random assignment of children to an MDFT group and an adolescent group therapy group. This study was conducted in the USA with a sample of adolescents between the ages of 13 and 19 (mean = 16.1) diagnosed with substance abuse problems or dependency. Measures Delinquent behaviours were measured using the National Youth Survey Self-Report Delinquency Scale (general delinquency and index offenses subscales) (adolescent self-report). Externalising symptoms were measured using the Youth Self-Report (externalising subscale) (adolescent self-report). Arrests were measured using administrative data from a justice system database maintained by the State of Florida. Psychological and behavioural depth of substance use involvement and related consequences was measured using the Personal Experience Inventory (Personal Involvement with Chemicals scale) (adolescent self-report). Substance abuse in the previous 90 days was measured using the Timeline Follow-Back Method (adolescent self-report). Findings This study identified statistically significant positive impact on a number of child outcomes. This includes delinquency (self-reported), externalising behaviour and felony arrests (in the post-test to 18-month follow-up period). Other studies The following studies were identified for this programme but did not count towards the programme's overall evidence rating. A programme receives the same rating as its most robust study or studies. Liddle, H. A., Dakof, G. A., Parker, K., Diamond, G. S., Barrett, K., & Tejeda, M. (2001). Multidimensional Family Therapy for adolescent drug abuse: Results of a randomized clinical trial. American Journal of Drug and Alcohol Abuse, 27 (4), Schmidt, S E., Liddle, H. A., & Dakof, G. A. (1996). Changes in parenting practices and adolescent drug abuse during Multidimensional Family Therapy. Journal of Family Psychology, 10, doi: / EIF Guidebook > Multidimensional Family Therapy 16

17 Liddle, H. A., Rowe, C. L., Dakof, G. A., Ungaro, R. A., & Henderson, C. E. (2004). Early intervention for adolescent substance abuse: Pretreatment to posttreatment outcomes of a randomized clinical trial comparing multidimensional family therapy and peer group treatment. Journal of Psychoactive Drugs, 36, doi: / Liddle, H. A., Rowe, C. L., Dakof, G. A., Henderson, C. E., & Greenbaum, P. E. (2009). Multidimensional family therapy for young adolescent substance abuse: twelve-month outcomes of a randomized controlled trial. Journal of consulting and clinical psychology, 77(1), 12. Henderson, C. E., Rowe, C. L., Dakof, G. A., Hawes, S. W., Liddle, H. A. (2009). Parenting practices as mediators of treatment effects in an early-intervention trial of multidimensional family therapy. American Journal of Drug and Alcohol Abuse, 35, doi: / Dennis, M., Godley, S. H., Diamond, G., Tims, F. M., Babor, T., Donaldson, J., Funk, R. (2004). The Cannabis Youth Treatment (CYT) study: Main findings from two randomized trials. Journal of Substance Abuse Treatment, 27, doi: /j.jsat Henderson, C. E., Dakof, G. A., Greenbaum, P. E., Liddle, H. A. (2010). Effectiveness of multidimensional family therapy with higher severity substance abusing adolescents: Report from two randomized controlled trials. Journal of Consulting and Clinical Psychology, 78, doi: /a Liddle, H. A., Dakof, G. A., Henderson, C. E., & Rowe, C. L. (2011). Implementation outcomes of multidimensional family therapy detention to community (DTC) A re-entry program for drug using juvenile detainees. International Journal of Offender Therapy and Comparative Criminology, 55, doi: / X Rowe, C. L., Alberga, L., Dakof, G. A., Henderson, C. E., Ungaro, R., & Liddle, H. A. (2016). Family-based HIV and sexually transmitted infection risk reduction for drug-involved young offenders: 42-month outcomes. Family Process, 55 (2), doi: /famp Marvel, F., Rowe, C. L., COLON PEREZ, L. I. S. S. E. T. T. E., DiClemente, R. J., & Liddle, H. A. (2009). Multidimensional Family Therapy HIV/STD Risk Reduction Intervention: An Integrative Family Based Model for Drug Involved Juvenile Offenders. Family process, 48(1), Liddle, H. A., Rowe, C. L., Gonzalez, A., Henderson, C. E., Dakof, G. A., & Greenbaum, P.E. (2006). Changing provider practices, program environment and improving outcomes by transporting Multidimensional Family Therapy to an adolescent drug treatment setting. The American Journal of Addictions, 15, doi: / Greenbaum, P. E., Wang, W., Henderson, C. E., Kan, L., Hall, K., Dakof, G. A., & Liddle, H. A. (2015). Gender and ethnicity as moderators: Integrative data analysis of multidimensional family therapy randomized clinical trials. Journal of Family Psychology, 29(6), 919. EIF Guidebook > Multidimensional Family Therapy 17

18 Guidebook The EIF Guidebook provides information about early intervention programmes that have at least preliminary evidence of achieving positive outcomes for children. It provides information based on EIF s assessment of the strength of evidence for a programme s effectiveness, and on detail about programmes shared with us by those who design, run and deliver them. The Guidebook serves an important starting point for commissioners to find out more about effective early interventions, and for programme providers to find out more about what good evidence of impact looks like and how it can be captured. As just one of our key resources for commissioners and practitioners, the Guidebook is an essential part of EIF s work to support the development of and investment in effective early intervention programmes. Our assessment of the evidence for a programme s effectiveness can inform and support certain parts of a commissioning decision, but it is not a substitute for professional judgment. Evidence about what has worked in the past offers no guarantee that an approach will work in all circumstances. Crucially, the Guidebook is not a market comparison website: ratings and other information should not be interpreted as a specific recommendation, kite mark or endorsement for any programme. How to read the Guidebook EIF evidence standards About the EIF Guidebook EIF Guidebook > Multidimensional Family Therapy 18

19 EIF The Early Intervention Foundation (EIF) is an independent charity and a member of the What Works network. We support the use of effective early intervention for children, young people and their families: identifying signals of risk, and responding with effective interventions to improve outcomes, reduce hardship and save the public money in the long term. We work by generating evidence and knowledge of what works in our field, putting this information in the hands of commissioners, practitioners and policymakers, and supporting the adoption of the evidence in local areas and relevant sectors. 10 Salamanca Place, London SE1 7HB +44 (0) EIF Guidebook > Multidimensional Family Therapy 19

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